N.Y. AG announces $268,000 settlement with medical center

By Bryan Cohen | Jul 23, 2013

BUFFALO, N.Y. (Legal Newsline) - New York Attorney General Eric Schneiderman announced a settlement Monday with Erie County Medical Center to resolve allegations that the center's dental clinic received Medicaid payments in violation of regulations.

Medicaid regulations allow for reimbursement for teeth cleanings once during a six-month period, unless there is a medical necessity for more frequent cleanings. ECMC's dental clinic allegedly billed Medicaid in violation of the rule for patients who received cleanings more often than once in six months. ECMC's dental clinic also allegedly billed for services it provided that were not properly documented, other services provided more frequently than allowed and services for which Medicaid does not provide reimbursement.

"For millions of New Yorkers, Medicaid provides access to critical and cost-effective health care services," Schneiderman said. "Those who abuse this integral program endanger the welfare of New York's most vulnerable citizens. My office is committed to ensuring that Medicaid is preserved for those who need it most."

ECMC conducted an internal audit of the period between Jan. 1, 2006, and Sept. 30, 2012, and self-disclosed the results to Schneiderman's office. At the request of Schneiderman's office, ECMC generated a series of billing reports which showed overpayments of $210,646.41 during the audit period. Schneiderman's office performed its own review and found additional overpayments of $57,849.09.

Under the terms of the agreement, ECMC will pay back $268,493.50 to Medicaid.

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